OFFICE USE ONLY

CITY OF LOS ANGELES

DEPARTMENT OF ANIMAL SERVICES P# _______________
B Check YES NO
1 on 1 YES NO
Emp # ____________
FOSTER APPLICATION Shelter ____________

Date: ____________________

____________________________________________________________________________
Last Name First Name MI

____________________________________________________________________________
Address City State Zip Code

______________________ _________________________ _______________________

Home Phone Cell Phone Work Phone

Email Address: ______________________________________________________________

Do You : Own Rent/Lease Residence Type: House Condo Apartment

If you Circled Rent/Lease, has you Landlord approved you to be a Foster Parent? YES NO

Do all household members agree to you fostering pets? YES NO

Do you have cat (s)? YES NO Have they tested negative for FELV/FIV? YES NO

List all pets that reside at your Address:

Current on all
Name Breed Age Sex Altered Vaccinations

1) ______________________________________________________________________

2) ______________________________________________________________________

3) ______________________________________________________________________

4) ______________________________________________________________________

5) ______________________________________________________________________

Who is your Veterinarian? _______________________________________________________

1
 Which Shelter would you like to be a Foster Parent for? (CIRCLE ONE ONLY)

EAST VALLEY WEST VALLEY NORTH CENTRAL

SOUTH LOS ANGELES HARBOR WEST LOS ANGELES

You will be required to bring foster pets in periodically for check-ups and vaccinations, do you
have transportation? YES NO

Are you willing to administer medication if need be? YES NO

Are you a member of a rescue organization? YES NO

If yes, which one? _____________________________________________________________

Have you ever been investigated by Animal Services? YES NO

If yes, explain _________________________________________________________________

_____________________________________________________________________________

Why do you want to foster? _______________________________________________________

_____________________________________________________________________________

Do you have experience with foster care for adult pets and un-weaned pets? YES NO

Please select your preference below and indicate how many pets that you would be willing to
foster at one time:

Kittens How many? ________ Adult Dogs How many? _______

Puppies How many? ________ Adult Cats How many? _______

______________________________________ _____________________
Foster Parent Signature Date
2
 CITY OF LOS ANGELES
DEPARTMENT OF ANIMAL SERVICES

FOSTER PARENT AGREEMENT

As a Foster Parent for the City of Los Angeles Department of Animal Services (LAAS) you
are required to abide by the terms of the Foster Parent Agreement. If accepted and in
consideration of becoming such, my initials and signature below, indicate that I understand
and agree to the following terms and conditions:

If applicable, All potential Foster Parents must attend a Bottle Baby Foster 1 on 1 training or
orientation.

Once a Foster Pet is weaned (8wks for puppies/kittens) it must be returned by the Foster Parent to the
Shelter and impounded back into Chameleon.

Foster Parent agrees to provide reasonable time, proper and sufficient food, water, shelter, kind
treatment, and proper veterinary medical care for the pet (s) in his/her care, at all times. Cats cannot
roam free. If your Foster Pet escapes, you will need to provide us with a written statement.

As with all pets, LAAS does its best to find each Foster Pet a good home; However, LAAS cannot
guarantee that all Foster Pets will be adopted nor guarantee, whatsoever, the health, temperament,
mental disposition, and training of any of the Shelter/Foster Pets.

LAAS will be allowed to inspect the premises, in which the Foster Pet (s) will be/are maintained,
from time to time, for the purpose of determining the suitability. Foster Pets are only temporarily in
my care and remain the property of LAAS and are subject to relinquishment at anytime. Failure to
return a Foster Pet will result in termination and a do not adopt status and legal action.

I agree that I will not relinquish custody of the Foster Pet (s) to anyone except LAAS, even
temporarily, and if the Foster Pet dies in my care, the body must be returned to the Shelter for
disposal and its death noted in our system.

I agree to contact LAAS immediately, if the Foster Pet (s); need medical care of any kind, and shall
be brought into the Shelter for further evaluation. At that time a decision will be made by LAAS
whether the Foster Pet (s) must stay at the Shelter or if they can return to the Foster home where the
Foster Parent will administer medications, if provided. Note: Private Veterinary costs incurred by
the Foster Parent WILL NOT be reimbursed by LAAS nor will other expenses such as food,
toys, litter.

I declare under penalty of perjury that all statements on this application form and
attachments are true and correct to the best of my knowledge. I understand that false,
misleading or incomplete information shall be cause for disqualification and/or
termination.

______________________________________ _____________________
Foster Parent Signature Date

3
 CITY OF LOS ANGELES
DEPARTMENT OF ANIMAL SERVICES

IDEMNITY WAIVER,
RELEASE OF LIABILITY AND ASSUMPTION OF RISK

I hereby agree that I will assume full responsibility for personal injury, property damage suffered
and/or death sustained as a result of, or in connection with, my participation as a volunteer with the
Los Angeles Animal Services (LAAS).

I agree, for purposes of this agreement, to release all employees, agents and/or volunteers
collectively from and against all liability, claims, demands, damages to my person or property
suffered and/or sustained as a direct and/or indirect result of my participation as a volunteer.

In connection with my participation as a volunteer, I further agree that I will not make any claim
against, sue, attach the property of, and/or prosecute the LAAS for any personal injury, property
damage, death, and/or whatever the cause of the event that gave rise to a claim.

I further understand that the behavior of domestic animals is unpredictable and that domestic
animals are capable of spreading disease, inflicting serious personal injury, causing extensive
property damage, and/or causing death. Knowing the risk of handling domestic animals,
nevertheless, I hereby agree to ASSUME THOSE RISKS and to release indemnity and hold
harmless LAAS, who might otherwise be liable to me (or my heirs or assigns), for damages.

It is understood and agreed that this Indemnity Waiver/Release of Liability and Assumption of Risk
form is intended to be binding on my heirs, distributes, guardians, legal representatives, and/ or
assigns.

I HAVE READ THIS AGREEMENT CAREFULLY AND FULLY. I AM AWARE THAT

THIS IS AN INDEMNITY WAIVER/RELEASE OF LIABILITY AND ASSUMPTION OF
RISK FORM AND IS A BINDING CONTRACT BETWEEN LAAS AND MYSELF. I SIGN
IT OF MY OWN FREE WILL.

______________________________________________ ___________________________
Foster Parent (Print Name) Date

__________________________________________ __________________________________
Foster Parent Signature Parent or Guardian, if between 16-17 yrs